Incident Report For Internal Use Only All information should be noted immediately and not left to memory 1. DO NOT admit fault regardless of the situation or circumstances 2. DO NOT indicate that you are collecting information for insurance purposes 3. DO take an adequate number of photographs to clearly document conditions present at the time of the incident.Report DateJobPerson Preparing ReportNature of Incident Injury to other trade employee Injury to general public Damage to other trade equipment Damage to public property Damage to underground utility Other (Describe below) Date of IncidentTime of IncidentWeather ConditionsDescription of Incident(Note attitude of claimant, i.e., interest in name of insurance company, obvious impairments, age, etc.)Persons InvolvedNameAddressPhone Location of IncidentWho reported the incident: Claimant Employee Authorities Family Other How was it reported: Phone call In person Voicemail message To an employee Other Person who first reported the incident:Name/Address/Phone#Witnesses or persons with knowledge of the incident:NameAddressPhone Were authorities notified? Police Fire Ambulance Other Who responded to the call?NameBadge#DepartmentReport/File Case# Please retain any copies of official reports and send to the OfficeWhat corrective action was taken?What future action will be taken?Were photographs taken? Yes No Please send any photographs via email